The connection between multiple plastic surgeries and body dysmorphic disorder is well known, but a new study underlines that plastic surgery patients may suffer from the disorder even if they don't look like they're campaigning to be on the next season of Real Housewives.

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A Belgian study published in Plastic and Reconstructive Surgery found that about a third of patients seeking nose jobs have moderate to severe BDD. Researchers followed 266 patients looking to have rhinoplasty, 80% of whom hadn't had a previous nose job. According to questionnaires completed by the patients, 33% were suffering from BDD. The number shot up to 43% among those who wanted rhinoplasty mainly for cosmetic reasons. For those patients seeking rhinoplasty to correct a breathing issue or another medical problem (like just about everyone in Hollywood), the incidence of BDD was only 2%.

The study also analyzed whether there's a link between the disorder and the patient's appearance. From LiveScience:

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The severity of BDD symptoms was unrelated to the actual appearance of the nose, according to an objective evaluation of each patient's nasal shape. Many patients who were highly concerned about their appearance had only minor defects or none, the study authors said.

We're unclear on how doctors were able to perform an "objective evaluation," as we were under the impression that nasal attractiveness is in the eye of the beholder.

The New York Timesreports that previous studies showed only about 10% of patients seeking plastic surgery suffer from BDD. Obviously patients wouldn't be seeking aesthetic rhinoplasties if they were totally happy with their noses, but University of Pennsylvania psychology professor David B. Sarwer explains that body dissatisfaction has to cross a line to be considered BDD:

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"It's when it begins to interfere with daily functioning. Patients with more severe B.D.D. struggle to maintain social relationships and have difficulty getting to work or staying employed."

The study authors say they hope their research will help doctors identify BDD patients and urge them to seek therapy rather than surgery. Unfortunately, there are far too many Dr. Nick Rivieras who are willing to operate anyway.